PCI before TAVR? New study provides answers, but questions remain
Percutaneous coronary intervention (PCI) does not appear to lower the risk of death or rehospitalization among patients undergoing transcatheter aortic valve replacement (TAVR), according to new findings published in JACC: Cardiovascular Interventions.
However, the authors emphasized, the noninferiority margin was not met, and additional research is still needed.
“Demand for TAVR is predicted to increase exponentially with an aging population,” wrote Tiffany Patterson, PhD, a cardiologist with Kings College London, and colleagues. “Coronary artery disease (CAD) has been shown to coexist in up two-thirds of cases, most likely attributable to overlapping risk factors. The presence of CAD is an independent predictor of outcome, and concomitant revascularization is recommended in patients with significant CAD undergoing surgical aortic valve replacement. However, there is currently insufficient evidence regarding the role of PCI in patients undergoing TAVR to inform guideline recommendations and clinical practice.”
Patterson et al. aimed to shed new light on this topic, tracking data from 235 patients with severe aortic stenosis and significant CAD. All patients underwent TAVR at one of 17 centers in the United Kingdom, France or Germany from December 2012 to January 2019. They were randomly assigned to either receive PCI prior to TAVR or skip PCI altogether.
Overall, the group found, death or rehospitalization occurred after one year in 41.5% of patients who underwent PCI and 44% of patients who did not. The rates of stroke, myocardial infarction and acute kidney injury did not appear to be impacted by the presence of PCI; however, undergoing PCI prior to TAVR was associated with a heightened risk of bleeding.
“Overall, there was no suggestion of a difference between the treatment strategies with increased bleeding risk in the PCI arm,” the authors wrote. “These findings should be taken into consideration by the heart team when deciding the best approach to CAD pre-TAVR, the duration of dual antiplatelet regime and timing of PCI in relation to TAVR.”
The authors also noted that studies examining patient outcomes after more time has passed would help determine “if there is a long-term mortality benefit of PCI prior to TAVR.”
The full study is available here.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.